Tuesday Talk: What are your thoughts on MNsure?

July 16, 2013
By
Joe Sheeran, Communications Director

To borrow a medical metaphor, Obamacare is a resilient patient, surviving a Supreme Court challenge and various gubernatorial and legislative attempts to infect and kill it. It’s still alive and about to get stronger in Minnesota. Starting in October, Minnesotans can purchase health insurance through MNsure, our state health insurance exchange. Actual coverage for these programs takes effect January 1. MNsure is expected to have a user-friendly website allowing patients to compare price and coverage, and let you know the monetary credits for which you qualify.

There’s still a lot of confusion and misinformation around Obamacare and the exchange. That’s why Minnesota 2020 is excited to have an exchange expert joining us this morning to straighten it all out. Between 8:30 and 9:45 am, Phillip Cryan, former member of the health insurance exchange taskforce and SEIU Healthcare organizing director, joins Tuesday Talk to answer your questions about moving Minnesota to near universal health care.

What are your thoughts on MNsure, our health insurance exchange, and Obamacare generally?

We had a great Q&A this morning! The discussion continues all day. Tell us your thoughts. Phillip will try to check in later to answer any remaining questions.

Thanks for participating! Commenting on this conversation is now closed.

47 Comments:

Aaron S. says:

July 16, 2013 at 8:21 am

Hi, Mr. Cryan,

I’ve heard a fair bit from state officials about how important it is to set up a state exchange rather than default to a “one size fits all” federal exchange. What are some of the unique factors in Minnesota’s health insurance market that our state-run exchange addresses, and how does it address them?

Aaron, it is a very, very good thing that MN lawmakers decided to set up a state-level exchange, rather than using the default federally-established option. One of the main reasons I say that is that we simply don’t know much yet about how the “one-size-fits-all” federal model will be set up, and we are just a few months away from enrollment starting in the exchanges. A more Minnesota-specific reason it’s a good thing—addressing your question about unique factors in our market—is that we have some standards in place in MN already that are, if not unique, better than most states. These include benefits that must be included in commercial insurance products and a long tradition of having only nonprofit health plans in the commercial market. (These plans have still generated substantial “excess revenue”—i.e., profits—but they’re not as predatory and harmful to consumers as some of the largest for-profit national chains. The federal model might make it harder to maintain those standards, through a “lowest common denominator” approach the feds may for practical reasons have to adopt. Minnesota can do better, and Minnesota will do better by establishing its own state-based exchange, MNSure.

Good question, Nikki. There’s a lot of confusion right now about who qualifies for coverage through the exchange, who should be looking at their new options once open-enrollment begins on October 1. Probably the most important thing to say in response to your question is that MNSure (the exchange in MN) is NOT for seniors. Medicare is for seniors, and while many seniors choose to purchase supplemental coverage and will surely continue to do so after Obamacare’s full implementation, that will continue to take place in a market that is wholly separate and distinct from the exchange.

The exchange, MNSure, is for some very specific groups of people to use. Anyone with quality, affordable health coverage through their employer will NOT use MNSure, and neither will seniors who qualify for Medicare. The same goes for people covered by TriCare or other military health insurance coverage. Here are the groups of people who will want to look to MNSure, starting October 1, to assess their new options:
* Anyone purchasing coverage on the individual market (that is, seeking coverage by themselves, outside of the context of employment/employer-sponsored insurance)
* Employees of small businesses (initially, those with 50 or fewer full-time employees), if the business owner chooses to offer coverage through MNSure
* Anyone whose income may qualify them for Medical Assistance (through the federal Medicaid program) or MinnesotaCare
MNsure will simplify the process of determining your eligibility for these different forms of coverage, and if you end up seeking commercial insurance through the exchange and have a household income that qualifies you for new Obamacare subsidies, it will tell you how much subsidy you can get and it will deduct that amount directly from your premiums when you enroll.

If people are currently receiving Medicaid, should they register with MNsure. How about if they are currently receiving MA or Minnesota Care or any other similar plan?

And to the below question if someone already has health insurance through an employer, but it is very expensive with a high deductible, would there be any reason not to register with MNsure to learn about options?

If someone is receiving Medicaid (MA) or MNCare today, they don’t need to do anything…..they will stay on it. If they’re on MNCare today but qualify for MA as of 1/1/14 through the Medicaid-expansion that passed this legislative session, they will be informed of that the next time they seek to re-enroll. Same goes for someone newly eligible for MNCare thanks to the MNCare-expansion that passed. The MNSure web site will let people determine their eligibility for those programs, and for different levels of subsidy on the exchange—in fact, you can already use the calculator tool on the MNSure web site to do this—but, as I mentioned earlier, actual enrollment in MA or MNCare may require taking some additional steps along the lines of what’s required for those programs today (though still a bit simpler than today, given that there’s no reporting of assets required).

On the second question, comparing individual-market options through the exchange with employer coverage may be worth doing if you think your employer coverage is really terrible, but there will be few cases where it’s SO terrible that an exchange policy WITHOUT SUBSIDIES is more affordable than employer-based coverage where the employer is paying for part of it.

Good morning! Glad to be here this morning to correspond with folks about all the changes coming to our health care system—and to the health insurance parts of that system in particular—January 1 of next year, as Obamacare (officially, the Patient Protection and Affordable Care Act) comes fully into effect.

Good morning! Will there be a need for people around the state to volunteer to be trained as Navigators or in-person assisters for MNSURE? Or will the enrollment process work primarily through established channels such as county health services, social service agencies, insurance agents, etc.

Great question. There is a huge need, I would say, for people around the state to seek training to be Navigators and in-person assisters for MNSure. It is pretty sobering to look at polling information on people’s knowledge of what’s going to happen with Obamacare, what the new options are, etc…...so it’s going to take a whole army of people doing outreach, education and enrollment at the grassroots level for everyone who qualifies for new coverage or new subsidies to find out about those opportunities, evade all the misinformation and lies opponents of the law will be generating, and actually get enrolled. MNSure itself (together with the counties, social service agencies, brokers) will do lots of great marketing and outreach, but it will never be enough. People throughout the state will need to a great deal of this work, both formally through the Navigator/in-person-assister programs and informally, leveraging the relationships they’re already in, talking to people who know them and trust them, whether that’s through a church, a community group, or any other kind of local grassroots organization.

Navigators/assisters must be associated with an organization certified to help MNsure customers, so anyone interested in volunteering should contact those community organizations to see if their help is needed.

Phillip, can you explain “active purchaser”... and why having only a few companies in the exchange is better than having any company who wants our business to sign up? It seems counter-intuitive to some to cut what’s perceived as competition.

The “active purchaser” approach is a way to generate more competition in the health insurance marketplace. It’s a very good thing that MNSure will have the authority to select which health plans to offer, starting 1/1/2015, because this is what will allow MNSure to push insurers to offer a better deal—higher quality, more affordable coverage—for all the consumers and small-business employees buying coverage through the exchange. Generating more competition in the individual and small-business health insurance markets is the whole point of exchanges, as a policy instrument, and “active purchaser” authority gives an exchange the tools it will need achieve that goal of enhancing competition.

The individual and small-business health insurance markets are completely dysfunctional today. In the language of economics, they suffer from a host of interlocking and very easily identified “market failures.” Creating an exchange will address a couple of those market failures—a couple of those reasons individual coverage and small-group coverage is so unaffordable today—like the inability for consumers to get accurate information about their options and make clear comparisons among their options. But an exchange without “active purchaser” authority—an exchange that would be required to offer any health plan product that met a set of minimum criteria, without the ability to select the best deals for consumers and weed out the worst ones—would make little headway in addressing one of the largest of the market failures in these health insurance markets: the outsized “market power” of the major firms offering coverage. In Minnesota’s dysfunctional individual market today, for example, where coverage is so bad and/or so unaffordable that many people seeking invividual policies never even take them out, because they can’t afford or because they can’t make sense of their options, Blue Cross’s market share is over 70%. It is not a competitive marketplace. The loudest opponents of “active purchaser” during the debate over state exchange legislation earlier this year—i.e., the health plans and the Chamber of Commerce—make it sound like the magic of the market is working great for consumers of individual and small-group health insurance. Not only common sense but also every public opinion poll on health insurance I’ve ever seen would suggest otherwise. “Active purchaser” will allow MNSure to push for a better deal on coverage for the hundreds of thousands of people buying policies through the exchange—just like Medicare gets a better deal on behalf of seniors, and just like a big employer like 3M gets a better deal by bargaining on behalf of their tens of thousands of employees.

I read a couple of years ago that, in virtually every state, two (or a very few) large insurers control almost all of the insurance market. In Minnesota it’s Blue Cross, HealthPartners (I believe) and Medica - which is sold by United HealthCare.

The Right Wing says the exchange should be open to as many insurers as would like to sell in Minnesota in order to ensure competition. It would mean, however, that companies selling low premium-very high deductible policies would siphon off business from the companies with higher premiums but more comprehensive coverage.

Even though we may pay a little more in premiums, we are probably better off knowing that all the insurers in the exchange are those who conform to our current laws and regulations rather than having to pay huge deductibles if we have a serious illness or need surgery.

Nothing prevents you from buying individual-market coverage through the Exchange, even if you’re offered employer-based coverage, BUT you can’t receive any of the Obamacare subsidies through the Exchange if you have an offer of coverage (even a halfway-decent offer of coverage, not necessarily a great one) from your employer. There are specific standards to provide exceptions to that—if the cost to you of that employer-based coverage is greater than 9.5% of your annual household income, or if the “actuarial value” of the coverage is below 60%—but for the vast majority of people who have an offer of coverage from their employer, they won’t be eligible for any subsidies on the Exchange and will likely want to stick with what they’ve got from their employer. (Or if they belong to a union, as I do, they’ll want to work to bargain for BETTER coverage through their employer, rather than jumping to the Exchange.)

Approx. how many insurance companies and policy options might be available through MnSure? Will the same core of companies now providing insurance in Mn. be offering the selection of Bronze, Silver, Gold and Platinum Plans?

We don’t know which companies have submitted policies to the Commerce Dept. for review, but we know that there are plenty of them. 11 companies (aka “health plans), if I remember the press accounts right. Each of them will be offering coverage at those different metal-levels, yes. Some may only be offering coverage in the individual market through MNSure, not the new small-employer market. It is almost a certainty that when all that information is made public, the same core group of companies in our individual and small-business markets today—and also in our public programs—will be offering coverage through MNSure: i.e., Blue Cross, Medica, HealthPartners, and UCare.

I can’t wait for MNsure. I’m very hopeful my premiums as a self insured business owner will go down. Am I wrong to think that?

Family of 5 pay $800/month with a $12,500/year deductible. We never go to the doctor, even though my son is ADHD. This year we raised our deductible because premiums rose to $1250/month. Feeling like I’m paying the middle man (insurance carrier) and not the real health care providers.

From what I have been able to understand (I’m going through the certification process to become a consumer assister), navigators and in-person assisters have essentially the same function. The difference is how they’re compensated: navigators enroll people in state health plans (such as MN Care or MA) and receive $25 per enrollment, because this was already in state statute. In-person assisters are a new category, and they enroll people in the other non-public health plans, receiving $70 per enrollment. Most/all agencies will do both roles simultaneously, just receiving different reimbursements depending on which plans their clients enroll in. I hope and assume that eventually the Legislature can fix this disparity in compensation—I know they’re aware of the issue.

Also, from what I’ve seen on the sample MNsure site, you could create an account, input your personal information, find out what assistance you may qualify for, and browse plans without actually purchasing coverage. I assume this is the distinction between registering with the site (creating an account) and enrolling in coverage (buying a plan). You can play with a prototype at http://www.ux2014.org/rp/prototype.html#home.

Thanks Colleen. Just want to make sure it’s clear that people can enroll directly on the web site on their own. The navigators and in-person assisters are going to provide the (critical) function of supporting people through the process, but the web site is being designed to be something that most people will be able to navigate through and enroll directly in coverage on without that support.

Phillip, do you have any sense of how ready the system will be to handle enrollments on October 1? Any new system has its wrinkles, and I worry that if MNsure isn’t ready to go that it will sully its own reputation and leave consumers and navigators frustrated. How confident is DHS about their readiness?

Another good question. I’m pretty confident the eligibility-determination and enrollment functions for exchange coverage and subsidies will be up and running October 1. It may take a little longer for eligibility and enrollment for public programs (Medical Assistance and MNCare) to be done through the same portal, but people will still be able to do that through the existing systems for those public programs, and evenetually they’ll get it to where you can do all three through MNSure. But for the core function of enrolling people and signing them up for subsidies in the new exchange, MNSure should be ready to go on day one, Oct. 1.

Good morning. I am a progressive and have a keen interest in healthcare issues. While I applaud any efforts to address this nation’s healthcare crisis, I find Obamacare a grave disappointment on a number of fronts. While it addresses some issues of accessibility and availability for groups that historically have been shut out of care, the overall issues of cost reduction and reform are largely not addressed. As I see it, we have made our current expensive and relatively poor quality healthcare now available to more people. I would feel more optimistic if in fact this represented a start to reform but our pattern has been to only tackle this issue every 15 years or so and I fear that rather than using Obamacare as a first step, we instead will spend the next decade defending the current bill. The flaws of Obamacare (and many exist) will be pushed to the forefront of discussion and will be used as Exhibit A that healthcare reform doesn’t work. Universal, single payer systems used in virtually every other developed nation is the only workable answer. I fear we will soon pay double what the rest of the world pays for a continually deteriorating product, all the time screaming at one another about the threat of socialism. I would have rather that Obamacare had not passed and we instead have worked toward a true national debate on this complicated and largely misunderstood issue.

While I respectfully—and strongly—disagree with you about it being better if Obamacare had not passed at all, I agree completely that much of the work of health care reform lies ahead of us still, not behind us with this one federal law. In particular, as you point out, the ACA is not so much a health CARE reform law as it is a health INSURANCE reform law. It’s in assessing its virtues as the latter that I strenuously disagree with you. 20-million-plus more people getting Medicaid coverage is huge. The law’s many new regulations on health insurers are huge. To take one example that hits very close to home: the elimination of lifetime caps on payments under a policy is the reason the parents of my 15-year-old god-daughter, who was diagnosed with leukemia three years ago, are not bankrupt, foreclosed-on, and ruined. The new insurance regulations affect different people in different ways, but for anyone who sees the benefit of one them directly as I have through my god-daughter, it’s pretty hard to sustain an argument that we’d be better off without this law.
But again, I completely agree with you about the need to focus in, much more than the ACA does, on health CARE reform. There are some useful tools and new funding in Obamacare to kick-start some of that, and our ability to move the conversation up to a higher level of policy and political priority will likely depend to a significant extent on whether some of those new projects and tools are successful.
Finally, though, the most important thing to say in response to your comment, I think, is: 2017. That’s when the ACA allows individual states to apply for a waiver to more substantially reform their health insurance and health care systems and get ACA-level federal financial support for it. States like Hawaii and Vermont are well on their way to preparing for their 2017 waiver applications to tackle some of the broader challenges of our health care system with more far-reaching reform. If we want Minnesota to be one of the states in position to do the same, we need to start organizing at the grassroots around this goal now.

I couldn’t agree with you more on your assessment that the bill was actually insurance reform rather than healthcare reform, but unfortunately that is not how it was portrayed or is viewed by most of the public. It seeks to reform a sick industry that needs less to be reformed and more to just disappear. Does any of the reforms help lower us paying 18% of our GDP on healthcare vs. 8-12% the rest of the world pays while covering 90%+ of their citizens? Bring on 2017 but what hope do you hold out for any Red state movig forward for more reform at that time? Is the best we can hope for that some states get reform, leaving others competing for third world healthcare status?

That’s an excellent question, Jeff. I have very little hope for any Red states moving forward with more reform in the next 2-4 years, given many of their terrible, morally-indefensible decisions this year to refuse Medicaid-expansion with massive federal taxpayer support (i.e., with only tiny costs to their states, or in many cases, outright savings compared to current policy). I think it will take having some states really innovate and prove the success of broader reforms—not in international comparison, which for some reason doesn’t seem to be judged relevant by many U.S. lawmakers—before we’ll have a real chance of pursuing those reforms in solid-Red states.

On your earlier question about the ACA and costs, recent analyses of the decline in U.S. healthcare cost inflation suggest that the ACA gets some of the credit (after you account for the poor economy’s clear effect on health care utilization). It’s really too soon to tell, but I think some of the components of reform included in the ACA will generate long-term declines in the rate of cost growth. But it won’t be enough, and it’s up to us to push for more—to build on Obamacare’s successes to achieve reforms that more comprehensively address the price/cost problems in our system.

One more question: it appears that MNsure has an “open enrollment” period with a time limit, just like one might have at an employer. I assume that people with qualifying life changes could access MNsure plans at other times of year, but what about folks who just missed the boat the first time? If outreach efforts don’t reach them in the open enrollment period, are they shut out until the following year? Will they have to pay a penalty for that?

Colleen, you’re exactly right about life events allowing enrollment. And also right about people needing to enroll during open enrollment, or else wait until the next year. But the very good news for the first year is that the open-enrollment period for 2014 coverage extends all the way from Oct. 1 2013 through March 31 2014. This is just for the first year, but it should be plenty of time—especially with the deluge of advertising, plus all the political and news chatter about the law—for people to find out about it get enrolled for this first year.

Most insurance markets—and it’s important to distinguish the context I’m talking about here from social insurance programs—don’t work without some rules and restrictions re: enrollment. If open enrollment was available year round, plenty of perfectly reasonable people would choose not to pay for insurance, knowing that they could enroll when they discovered they needed care.

I think this is a wonderful idea…and though I was unable to attend the discussion, I look forward to the Hindsight Blog.

One thing: Must we persist calling this important legislation Obamacare? Why don’t we call it the Affordable Care Act? The term “Obamacare” is meant to signal confusion and misalignment of principles. Affordable Care is all about benefits.

Thank you for this discussion. Do you know how or if any of the Complementary and Alternative care providers are covered under the ACA? Most of my healthcare is achieved through chiropractic, acupuncture, and an herbalist. If the MNsure plans do cover chiropractic and acupuncture, will they all offer the same coverage or will we be able to see their differences?

My wife was on Minnesota Care through May 2013. She was dropped because my last dependent turned 21 and our income was $340 a month over. I am turning 66 and loosing my long term disability income of $300 per month. Will there be any changes in Minnesota Care for 2014 in the income limits or in the changes for dependents 21-26?

Chris: I would need a lot more information to be able to answer the “what gives?” question. Try calling MNSure’s call center/help line to explain your searches and ask what could account for the different results.

I am currently on medicare and paying for a supplemental policy> I am low income, so should I seek coverage thru MnSure?
My monthly income is approximately 1500.00 and I pay 167.00 for my supplemental insurance, and of course the 100.00 which is taken out of my social security disability check.

Hi Beth. The former Senior Federation operated a referral service called Senior Partners. It consisted of some 500 doctors and clinics throughout Minnesota who had agreed to accept whatever Medicare paid for a service as full payment. Medicare patients patronizing these providers therefore could avoid buying gap insurance. (Gap insurance pays 80% of the 20% of an allowed payment that Medicare does not pay.)

The program still exists but is now operated out of a Senior organization in the west Metro (Minnetonka?). I don’t have their name but the Senior Partners Care program information number is 952-541-1019 Ext 318. They can tell you whether or not your income is low enough for you to qualify for the program.

It sounds like you should try either contacting MNsure yourself (1-855-366-7873) or contacting a local Assister who can help you out. Assister services are free and Assisters are trained by the state to help MNsure applicants. Find one in your local area at https://www.mnsure.org/tools/locater/index.jsp.